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An Analysis of the Risk Factors for the Failure of Respiratory Support With High-flow Nasal Cannula Oxygen Therapy in Children with Acute Respiratory Dysfunction: a case-control study
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  • Jie LIU,
  • De-yuan LI ,
  • Li-li LUO ,
  • Zhong-qiang LIU ,
  • Xiao-qing LI ,
  • Li-na QIAO
Jie LIU
Sichuan University West China Second University Hospital
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De-yuan LI
Sichuan University West China Second University Hospital
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Li-li LUO
Sichuan University West China Second University Hospital
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Zhong-qiang LIU
Sichuan University West China Second University Hospital
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Xiao-qing LI
Sichuan University West China Second University Hospital
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Li-na QIAO
Sichuan University West China Second University Hospital
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Abstract

Objective:High-flow nasal cannula oxygen therapy (HFNC) is a new type of non-invasive respiratory support technique that widely used in pediatric intensive care units (PICUs);however,improper use of HFNC is likely to bring adverse outcomes to critically ill children.Our objective of this study was to identify the risk factors for the failure of HFNC.Study design: Divided the patients into different categories: HFNC success group, a 48h failure group, a 24h failure group, and a 2h failure group.The clinical indexes and the change trend in HFNC before and after treatment were dynamically observed in 67 pediatric patients. Risk factors for HFNC failure were determined using multivariate logistic regression analysis.Results:PRISM III score>4 points and PaCO2>43 mmHg were risk factors for 48h failure (OR were 4.064, 4.516, P<0.05); PaCO2>43 mmHg was risk factors for 24 h failure (OR was 3.152, P<0.05); PRISM III score>6.5 points and PaCO2/PaO2 ratio>0.67 were risk factors for 2 h failure (OR were 27.977, 64.366, P<0.05) and the risk of HFNC failure increased more than 5 times when the PaO2/FiO2 ratio decreased by>28% after 2 h of HFNC treatment, and the invasive mechanical ventilation time was statistically longer in the patients that upgraded from HFNC to invasive respiratory support than that of patients who received invasive respiratory support directly(P<0.05).Conclusions:The PRISM III score, PaCO2 and PaCO2/PaO2 ratio were risk factors for HFNC failure.Totally the shorter the failure time, the higher the values of the risk factors were, and the higher the failure risk of HFNC was. The change in the PaO2/FiO2 ratio before and after HFNC is a warning indicator for early HFNC failure. And early HFNC failure might lead to prolonged invasive mechanical ventilation.

Peer review status:UNDER REVIEW

12 Feb 2021Submitted to Pediatric Pulmonology
12 Feb 2021Assigned to Editor
12 Feb 2021Submission Checks Completed
20 May 2021Reviewer(s) Assigned